Provider Demographics
NPI:1619340858
Name:ICT SERVICES, INC.
Entity Type:Organization
Organization Name:ICT SERVICES, INC.
Other - Org Name:COMMONWEALTH ICT SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:BRIANNA
Authorized Official - Last Name:KETNER-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-351-0057
Mailing Address - Street 1:6465 COLLEGE PARK SQ STE 300
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3622
Mailing Address - Country:US
Mailing Address - Phone:757-351-0005
Mailing Address - Fax:757-351-6890
Practice Address - Street 1:6465 COLLEGE PARK SQ STE 300
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3622
Practice Address - Country:US
Practice Address - Phone:757-351-0057
Practice Address - Fax:757-351-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017483470001Medicaid
VA16186Medicaid
VA30017483470002Medicaid